The Practical Guide to the Identification, Evaluation and Treatment of Overweight and Obesity in Adults
National Institutes of Health and National Heart, Lung, and Blood Institute. October 2000. NIH Publication No. 00-4084. 78 pages.
In response to the increasing prevalence of overweight and obesity in the United States, Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: Evidence Report was released by the National Heart, Lung, and Blood Institute Obesity Education Initiative in June 1998. The expert panel that developed the clinical guidelines then prepared this practical guide, which describes how physicians, nurses, registered dietitians, and nutritionists in a primary care setting can provide direction and support to their patients to effectively lose weight.
This booklet provides concise clear steps in evaluating a patient's weight and risk factors, as well as a variety of useful and practical information to be shared with the patient. The rationale for using body mass index (BMI) and waist circumference in evaluating a patient's weight is presented, as well as a BMI table. A treatment algorithm describes the initial evaluation of a patient's weight and possible treatment options. In addition, a behavioral assessment guides the practitioner in assessing the patient's readiness for weight loss. The main tools for weight loss espoused here are lower caloric intakes coupled with increases in physical activity. Various risk factors are covered, as well as weight loss after age 65.
The only drugs for weight loss that are covered are sibutramine (Meridia) and orlistat (Xenical). According to the report, "Herbal medications are not recommended as part of a weight-loss program"(p37). However, patients are bombarded with information about weight-loss herbal therapies and many have questions about the efficacy of herbal preparations. Unfortunately, this booklet provides only cursory information on herbal preparations and does not offer specific information on the most accessible herbal products on the market. To effectively guide patient choices, practitioners must be able to answer their patients' questions, which will undoubtedly include questions about herbal preparations.
The last 30 pages of this booklet are composed of information to be given to patients and include how to shop and read labels, low-calorie and lower fat alternatives, sample reduced-calorie menus, food-exchange lists, and food-preparation and dining out hints. The sample menus reflect the geographic ethnicity of America and include Asian, Mexican, southern, and lacto-ovo cuisine. Guides to physical activity and behavior change complete the patient information section.
In summary, this practical guide lives up to its name. For advanced practice nurses who encounter patients who are overweight or obese, this booklet provides succinct easy-to-understand steps to evaluate and guide a patient's weight-loss program.